Department of Neurology and Clinical Neurophysiology, Medical School of Hannover, Hannover, Germany.
Pain Med. 2009 Mar;10(2):300-3. doi: 10.1111/j.1526-4637.2008.00554.x. Epub 2009 Jan 16.
Phantom limb pain and sensations are common in amputees. The pathophysiology remains unclear and the treatment difficult and often unsuccessful. Opioids are frequently used when non-narcotics have failed, but are not effective in many cases. We report on three phantom and stump pain patients, refractive to previous treatments, who were successfully treated with botulinum toxin A (BoNT-A).
Three patients who had previously undergone amputation of their leg due to accident (N = 2) or injury by a landmine (N = 1) were treated with BoNT-A (Dysport). We injected a total dose of up to 500 units (U) BoNT-A under EMG-control. Global clinical improvement was based on a 0-3 scale (0 = no effect; 3 = marked improvement) and on a questionnaire rating pain intensity (based on the visual analog scale), intake of pain medication and phantom limb sensations.
All three patients evaluated the clinical global improvement with 3 (marked improvement). The pain intensity and pain medication was reduced significantly in all three cases. No side effects were reported. The duration of response lasted up to 11 weeks.
These three successfully treated phantom and stump pain patients show that therapy with BoNT-A may be worth studying as an effective and safe treatment option for this kind of pain.
幻肢痛和幻肢感在截肢患者中很常见。其病理生理学仍不清楚，治疗也很困难，而且往往不成功。当非麻醉性药物治疗失败时，经常使用阿片类药物，但在许多情况下并不有效。我们报告了 3 例幻肢和残肢疼痛患者，他们对以前的治疗有反应，使用肉毒杆菌毒素 A (BoNT-A) 治疗成功。
3 名因事故（N=2）或地雷伤（N=1）而截肢的患者接受 BoNT-A（Dysport）治疗。我们在肌电图控制下注射了多达 500 个单位（U）的 BoNT-A。总体临床改善基于 0-3 级评分（0=无效果；3=明显改善）和问卷调查评定的疼痛强度（基于视觉模拟评分）、止痛药的摄入和幻肢感觉。
所有 3 名患者均评估临床总体改善为 3 级（明显改善）。所有 3 例患者的疼痛强度和止痛药的摄入均显著减少。未报告任何副作用。反应持续时间长达 11 周。
这 3 例成功治疗的幻肢和残肢疼痛患者表明，BoNT-A 治疗可能是一种有效且安全的治疗选择，值得对此类疼痛进行研究。
